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Heart 1999;81:171-176; doi:10.1136/hrt.81.2.171
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1999;81:171-176 ( February )

Effects of reconstructive surgery for left ventricular anterior aneurysm on ventriculoarterial coupling

F Fantini,a G Barletta,a A Toso,a M Baroni,b M Di Donato,a M Sabatier,c V Dorc

a Institute of Internal Medicine and Cardiology, University of Florence, Via delle Masse 125, 50141 Florence, Italy, b Department of Electronic Engineering, University of Florence, c Cardiothoracic Centre of Monaco, Monaco

Correspondence to: Professor Fantini. email: f.fantini{at}dfc.unifi.it

Accepted for publication 2 September 1998

Objective---To investigate left ventricular elastance (Emax) and effective arterial elastance (Ea) in postinfarction left ventricular aneurysm and evaluate their role in left ventricular function improvement after endoventricular circular patch plasty (EVCPP). Ventriculoarterial coupling has never been studied in these patients.
Patients---22 consecutive patients (49 to 73 years) with left ventricular anterior aneurysm.
Methods---Haemodynamic studies were done before and two weeks after EVCPP. Ventriculography was performed during atrial pacing (100 beats/min). Pressure/volume loops were analysed and derived parameters measured. Emax was estimated by applying the "single beat" method. Ea was calculated as end systolic pressure/stroke volume.
Results---Left ventricular volumes and Ea decreased after surgery: end diastolic volume index from mean (SD) 155 (53) to 106 (29); end systolic volume index from 112 (51) to 62 (30) ml/m2 (both p < 0.0001); Ea from 1.65 (0.70) to 1.39 (0.41) mm Hg/ml (p = 0.04). Ejection fraction and Emax increased, without significant changes in stroke volume and work. The decrease in Ea was directly correlated with its preoperative value. The time interval between left ventricular pressure upstroke and peak systolic pressure decreased, from 237 (39) to 191 (41) ms (p < 0.0001), paralleling morphological changes in pressure tracings.
Conclusions---After EVCPP, ventriculoarterial coupling improves because of the fall in Ea caused by end systolic pressure reduction. The improvement is related to aortic pressure waveform changes and improved relaxation.

Keywords: left ventricular aneurysm; left ventricular function; arterial elastance; ventriculoarterial coupling

© 1999 by Heart
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